HCR-20 Violence Risk Assessment Scheme Research Articles

Smurtinio elgesio rizikos vertinimas: HCR-20 prognostinis validumas už smurtinius nusikaltimus teistų asmenų imtyje

Criminal risk assessment has been intensively investigated over the last decades. There­fore, the four generations of risk assessment instruments have already been developed (Blomberg et al., 2010) starting from unstructured clinical judgment (first generation), via actuarial risk assessment (second generation), and leading to structured clinical judg­ment (third generation) and assessment-based risk management (fourth generation). The HCR-20 violence risk assessment scheme (Webster et al., 2007) is an instrument of the third generation, which recognizes the importance of both static and dynamic risk management factors as well as contains the elements of prediction, a specific assessment procedure, and risk communication. The HCR-20 can be applied in different settings: fo­rensic, correctional, or community. Moreover, the research has shown (Dahle, 2006; Gray et al., 2008) that the HCR-20 is reliable for assessing the risk of general and non-violent criminal behavior. In Lithuania, risk assessment is relatively new. The Law of Probation, which came into force in July 2012, defines the concept of risk assessment as a standardized investigation aimed at determining both the probability of re-offence and possibilities to reduce it. The current study describes the psychometric variables of the Lithuanian version of the HCR-20 and measures its predictive validity in a correctional sample of violent offenders. The sample consisted of 74 male offenders from Vilnius, Alytus, and Pravieniškės correctional institutions. The mean age of the population at the initial stage of evalu­ation was 33.15 years. The number of convictions varied from 1 to 12; convictions for violence varied from 1 to 4. All participants were assessed with the HCR-20, and their data were analyzed in two ways: calculating the total HCR-20 score, and measuring the level of risk based on the weight of risk factors rather than on their quantity. The sec­ond stage of the research was conducted after 5 years of approaching the information regarding data on the further convictions of the research participants. The results have shown that within the period of 5 years, the AUC values for the HCR-20 final risk judgment can significantly predict the risk of both a general as well as a violent crime (respectively, AUC = 0.64 and AUC = 0.73). Therefore, it may be con­cluded that the HCR-20 is a valid and reliable instrument for assessing the risk of future recidivism (both general and violent). However, it should be noted that a good predictive validity is related to the final risk judgment, while the total arithmetical score is signifi­cant for predicting the general recidivism only.

The Validity of Version 3 of the HCR-20 Violence Risk Assessment Scheme Amongst Offenders and Civil Psychiatric Patients

The current study presents an empirical evaluation of the performance of the third version of the HCR-20. This prospective research project was conducted using a sample of 106 offenders and psychiatric patients who were transitioning out of institutions and into the community. Results provided strong support for the bivariate associations between the ratings of the presence and relevance of risk factors, as well as summary risk ratings, and violence at 4 to 6 weeks and 6 to 8 months. Although relevance ratings did not add incrementally to presence ratings, summary risk ratings added incrementally to both. Findings were not moderated by either sub-sample or gender. Version 3 of the HCR-20 was highly correlated with Version 2. Associations with violence were comparable between instruments. Findings were supportive of these basic elements of Version 3.

2124 – Assessment and treatment of patients with violent behaviors in emergency psychiatry. The HCR-20 violence risk assessment scheme

Introduction Violent behavior of patients is a common problem in emergency psychiatry and evaluation, diagnosis, management and treatment of which is very difficult.The absence of a test that could be used to predict violent behavior hampers proper decision in the case of emergency admissions, as well as discharge from the hospital. The application of such a test would upgrade assessment offering solve this problem. Objective To identify risk and protective factors of violent behaviors : to establish the degree to which the HCR-20 predicts the frequency and severity of violent behavior; to examine the predictive validity of the scales of the HCR-20. Goal Improve assessment, management and treatment of patients with violent behaviors in the psychiatric ward. Method Prospective cohort study, during 24 weeks. Psychiatric evaluation based on structural clinical interviews and questionnaires related to violent behaviors and risk factors were conducted to patients admitted in psychiatric hospital on UHC “Mother Tereza” Tirana. Results According to our data, the relationship between violence and mental illness vary considerably across different diagnoses. The highest rate of violence is reported in subjects with substance abuse disorder and antisocial personality disorder followed by Bipolar disorder and psychotic patients. Among the risk factors verified so far, the past violence behaviors reported show the highest predictive value. Conclusions HCR-20 tool has currently shown good results to roughly estimate probability of future violence and taking appropriate measures in order to prevent unwanted consequences.

HCR-20 violence risk assessments as a guide for treating and managing violence risk in a forensic psychiatric setting

Over the past decades there has been a vast development in the research into risk factors for violence and the development of risk assessment instruments. One instrument that has been given special attention is the HCR-20 violence risk assessment scheme. However, little attention has been paid to the clinical applicability of this tool, i.e. how does this assessment scheme perform when utilized in clinical practice as a tool to guide intervention and management in order to alleviate risk of violent behaviour? The present study was a true prospective study into the utilization of the HCR-20 as a clinical routine. Data on forensic psychiatric patients (n = 81) from a forensic unit in Denmark are presented. As part of a clinical routine all patients were assessed for risk of future violence utilizing the structured professional judgement model, the HCR-20. Outcome measures were aggressive episodes during hospitalization and new convictions post discharge. The predictive validity of the HCR-20 was lower compared with previous findings. It is argued that this does not necessarily indicate poor predictive accuracy of the HCR-20. Rather, it may indicate that the HCR-20 is suitable for guiding risk management in order to prevent violent behaviour.

Validity of assessing people experiencing mental illness who have offended using the Camberwell Assessment of Need–Forensic and Health of the Nation Outcome Scales–Secure

Evidence-based practices for forensic mental health services have been slow to develop, and there is a lack of measures that assess the mental health and criminogenic needs of people experiencing mental illness who have offended. The present study aimed to investigate the interrelationship between a clinician-rated forensic mental health needs assessment (Health of the Nation Outcomes Scales-Secure (HoNOS-S)), a forensic mental health needs assessment that considers both clinician and patient perspectives (Camberwell Assessment of Need-Forensic (CANFOR)), and measures of general and violent recidivism (Level Service-Case Management Inventory (LS-CMI) and HCR-20 Violence Risk Assessment Scheme (HCR-20)). Needs were assessed for 72 forensic patients aged between 20 and 62 years of age, located in a secure forensic mental health facility. The findings revealed significant positive correlations between the HoNOS-S, CANFOR, and HCR-20. Only the CANFOR was positively correlated with the LS-CMI, and uniquely contributed variance to the HCR-20. Patients and nurses differed in the total number of needs and met needs they identified as present. The findings suggest that the collaborative approach of the CANFOR might be more appropriate for measuring outcomes in the treatment of individuals experiencing mental illness who have offended.

Violence Risk Assessment and Women: Predictive Accuracy of the HCR‐20 in a Civil Psychiatric Sample

Research to date has not adequately demonstrated whether the HCR-20 Violence Risk Assessment Scheme (HCR-20; Webster, Douglas, Eaves, & Hart, 1997), a structured violence risk assessment measure with a robust literature supporting its validity in male samples, is a valid indicator of violence risk in women. This study utilized data from the MacArthur Study of Mental Disorder and Violence to retrospectively score an abbreviated version of HCR-20 in 827 civil psychiatric patients. HCR-20 scores and predictive accuracy of community violence were compared for men and women. Results suggested that the HCR-20 is slightly, but not significantly, better for evaluating future risk for violence in men than in women, although the magnitude of the gender differences was small and was largely limited to historical factors. The results do not indicate that the HCR-20 needs to be tailored for use in women or that it should not be used in women, but they do highlight that the HCR-20 should be used cautiously and with full awareness of its potential limitations in women.

Predicting violence in psychiatric inpatients: a prospective study with the HCR-20 violence risk assessment scheme

This prospective longitudinal study explores the predictive validity of the HCR-20 and the Psychopathy Checklist: Screening Version (PCL:SV) in a mentally disordered high-risk population. Files of 78 inpatients were coded and patients were followed up while in hospital for 12 months by nursing staff who recorded violent incidents using the Modified Overt Aggression Scale. Receiver operating characteristic analyses yielded moderate to strong associations between HCR-20 and violence (AUCs = .69–.77). PCL:SV AUCs were lower and more unstable (.61–.70). Regression analyses revealed that both tools were good violence predictors in the short-term, but only HCR-20 and particularly the clinical subscale contributed to prediction beyond this period. Patients scoring above the HCR-20 mean were 2.1–2.5 times more likely to be violent than those scoring below the mean. The results suggest that the HCR-20's Spanish adaptation is a useful tool for predicting the likelihood of inpatient violence in civil psychiatric wards. Implications for risk assessment research are discussed.

Risk Assessment: The Value of Structured Professional Judgments

International research suggests that using formalized risk assessment methods may improve the predictive validity of professionals’ predictions of risk of future violence. This study presents data on forensic psychiatric patients discharged from a forensic unit in Denmark in year 2001–2002 (n =107). All patients were assessed for risk of future violence utilizing a structured professional judgment model: the HCR-20 violence risk assessment scheme. After a follow-up period of 5.6 years, recidivism outcome were obtained from the Danish National Crime Register. Overall, the predictive validity of the HCR-20 was good. The structured final risk judgment had the highest predictive accuracy of violent recidivism and was superior to the HCR-20 used in an actuarial manner. At the individual item level, a higher number of the dynamic items were significantly predictive of violent recidivism compared to static items. In sum, the findings support the use of structured professional judgment models of risk assessment and in particular the HCR-20 violence risk assessment scheme. Findings regarding the importance of the (clinical) structured final risk judgment and the individual dynamic items strengthen the use of this scheme in clinical practice.

Evaluation of the HCR-20 Violence Risk Assessment Scheme in a Belgian forensic population

Violence risk assessment constitutes a major concern in forensic psychiatry, psychology and related fields. Numerous instruments like the Hare Psychopathy Checklist (PCL-R, Hare, 1991) and the Violence Risk Appraisal Guide (VRAG) have been developed in the aim of improving precision in the prediction of violence. This study assesses the reliability index of the HCR-20 Violence Risk Assessment Scheme and evaluates its relationship with the PCL-R the Buss and Perry's self-report Aggression Questionnaire (AQ) and the type of offenses officially registered. All participants (n=86) are male adult offenders detained in a Belgian high-security forensic hospital. The mean IQ and age were respectively, 81,03 and 36,71. Items common to these instruments were omitted in order to avoid a circular effect. Results showed that the HCR-20 was significantly related to the PCL-R: the historical factor was strongly correlated to the PCL-R factor 2 while the clinical factor was strongly correlated to the PCL-R factor 1. The HCR-20 was significantly related to the AQ: the historical factor was strongly correlated to the AQ Physical Aggression factor and to the Anger factor. As regards to the HCR-20 relations with offenses, its Historical factor was related to both violent (assault and battery, robbery) and non-violent offenses (drug offenses, theft). Finally, the HCR-20 was also positively related to "instrumental" and rather premeditated homicide but negatively related to psychotic homicide. The overall findings are congruent with -published data on the convergent validity of the HCR-20.

Evaluation of a model of violence risk assessment among forensic psychiatric patients.

This study tested the interrater reliability and criterion-related validity of structured violence risk judgments made by using one application of the structured professional judgment model of violence risk assessment, the HCR-20 violence risk assessment scheme, which assesses 20 key risk factors in three domains: historical, clinical, and risk management. The HCR-20 was completed for a sample of 100 forensic psychiatric patients who had been found not guilty by reason of a mental disorder and were subsequently released to the community. Violence in the community was determined from multiple file-based sources. Interrater reliability of structured final risk judgments of low, moderate, or high violence risk made on the basis of the structured professional judgment model was acceptable (weighted kappa=.61). Structured final risk judgments were significantly predictive of postrelease community violence, yielding moderate to large effect sizes. Event history analyses showed that final risk judgments made with the structured professional judgment model added incremental validity to the HCR-20 used in an actuarial (numerical) sense. The findings support the structured professional judgment model of risk assessment as well as the HCR-20 specifically and suggest that clinical judgment, if made within a structured context, can contribute in meaningful ways to the assessment of violence risk.

The impact of confidence on the accuracy of structured professional and actuarial violence risk judgments in a sample of forensic psychiatric patients.

Some previous research indicates that confidence affects the accuracy of probabilistic clinical ratings of risk for violence among civil psychiatric inpatients. The current study investigated the impact of confidence on actuarial and structured professional risk assessments, in a forensic psychiatric population, using community violence as the outcome criteria. Raters completed the HCR-20 violence risk assessment scheme for a sample of 100 forensic psychiatric patients. Results showed that accuracy of both actuarial judgments (HCR-20 total scores) and structured professional judgments (of low, moderate, and high risk) were substantially more accurate when raters were more confident about their judgments. Findings suggest that confidence of ratings should be studied as a potentially important mediator of structured professional and actuarial risk judgments.

Treatment Effects on Forensic Psychiatric Patients Measured With the HCR-20 Violence Risk Assessment Scheme

This study focuses on the foundational issue of change in violence risk factors in forensic psychiatric patients across multiple assessment periods using the HCR-20 scheme. HCR-20 assessments performed on 150 forensic psychiatric patients at two special (forensic) hospitals in Sweden were studied in relation to the patients' time at institution, with the aim to investigate a possible relation between level of risk and time at institution. A sub-group was followed across an 18-month period of institutionalization to investigate possible changes in risk factors over time. The latter patients were assessed with the HCR-20 three times, with six months between the assessments. Patients with longer treatment times had lower scores on the HCR-20 Clinical and Risk Management sub-scales, compared to patients who had been admitted to the hospitals for a shorter period of time. This finding was particularly evident on the cross-sectional analyses with respect to the R scale. The clinical risk factors in the C scale also dropped overall in connection with treatment time across both cross-sectional and prospective analyses, although not as substantially as the R scale. The results are consistent with and provide support for the HCR-20 system's proposition that the C and R scales are dynamic, or prone to change.

Comparison of hcr-20 scores in violent mentally disordered men and women: Gender differences and similarities

Retrospective risk assessments based on the HCR-20 violence risk assessment scheme were performed on 63 female patients and 85 male patients at two special forensic psychiatric hospitals. The aim was to compare risk factors for violence in mentally disordered women with their male counterparts, and to study to what extent the HCR-20, which is mainly based on research on men, can be used in a female forensic psychiatric population. The results show that the HCR-20 displays very similar risk factors for violence in women as in men, but the nature of violence is somewhat different between the sexes. Implications of the findings are discussed.

Assessing risk for violence among psychiatric patients: The HCR-20 violence risk assessment scheme and the Psychopathy Checklist: Screening Version.

This study evaluated the predictive validity of the HCR-20 (Historical, Clinical, and Risk Management) violence risk assessment scheme and the Psychopathy Checklist: Screening Version (PCL:SV). Files of 193 civilly committed patients were coded. Patients were followed up in the community for an average of 626 days. Receiver operating characteristic analyses with the HCR-20 yielded strong associations with violence (areas under curve [AUCs] = .76-.80). Persons scoring above the HCR-20 median were 6 to 13 times more likely to be violent than those scoring below the median. PCL:SV AUCs were more variable (.68-.79). Regression analyses revealed that the HCR-20 added incremental validity to the PCL:SV and that only HCR-20 subscales predicted violence. Implications for risk assessment research, and the clinical assessment and management of violence, are discussed.

The HCR-20 Violence Risk Assessment Scheme

The Historical, Clinical, and Risk Management (HCR-20) violence risk assessment scheme was coded in a sample of 75 Canadian male, federally sentenced, maximum-security offenders. The concurrent validity of the HCR-20 was assessed through comparison to other risk instruments and to the presence of several past indexes of violent and antisocial behavior. The HCR-20 showed moderate to strong relationships with the concurrent measures. The HCR-20 was as or more strongly related to past violence than were the Psychopathy Checklist—Revised or the Violence Risk Appraisal Guide. Scores above the median of the HCR-20 increased the odds of the presence of various measures of past violence and antisocial behavior by an average of four times. Although recognizing the limitations of a small sample and retrospective design, the results give some indication that the HCR-20 may be worth investigating as a useful tool for violence risk assessments in correctional samples.

Assessing risk for violence among psychiatric patients: the HCR-20 violence risk assessment scheme and the Psychopathy Checklist: Screening Version.

This study evaluated the predictive validity of the HCR-20 (Historical, Clinical, and Risk Management) violence risk assessment scheme and the Psychopathy Checklist: Screening Version (PCL:SV). Files of 193 civilly committed patients were coded. Patients were followed up in the community for an average of 626 days. Receiver operating characteristic analyses with the HCR-20 yielded strong associations with violence (areas under curve [AUCs] = .76-.80). Persons scoring above the HCR-20 median were 6 to 13 times more likely to be violent than those scoring below the median. PCL:SV AUCs were more variable (.68-.79). Regression analyses revealed that the HCR-20 added incremental validity to the PCL:SV and that only HCR-20 subscales predicted violence. Implications for risk assessment research, and the clinical assessment and management of violence, are discussed.